Recurrence of uveal malignant melanoma: a case report.

BACKGROUND: Malignant melanoma of uveal tract is a rare ocular malignancy. It is one of the significant causes of ocular morbidity and mortality which is less commonly seen in children. CASE: We report an unusual case of orbital recurrence of malignant melanoma in a 14-year old boy who had previously undergone enucleation of the left painful blind eye 8 months ago. He was diagnosed to have uveal malignant melanoma elsewhere which was confirmed by histopathology. Orbital recurrence was managed with modified exenteration with adjuvant chemotherapy and radiotherapy. CONCLUSION: In all treated cases of uveal melanoma, close follow up examination and monitoring is necessary for early diagnosis of the recurrence and to plan for further management.

Lamellar ichthyosis presenting as bilateral spontaneous corneal perforation.

INTRODUCTION: Lamellar Ichthyosis is an autosomal recessive, inherited skin disorder characterized by thickening, fissuring and scaling of the skin. OBJECTIVE: To report a case of lamellar icthyosis and highlight the importance of monitoring corneal health in these patients. CASE: We report a rare case of bilateral spontaneous corneal perforation in a patient with lamellar ichthyosis .The patient presented with complaints of diminution of vision, foreign body sensation, watering and discharge in both of his eyes for the last three months followed by pain and redness for one week. Visual acuities were light perception in both the eyes. Cicatricial ectropion was seen in both the lower eyelids. Corneal perforation was seen in both the eyes. Lamellar ichthyosis was diagnosed on the basis of scaling and excessive dryness of the entire body skin and was confirmed by skin biopsy. Peneterating keratoplasty of both eyes was done with cataract surgery of the right. The systemic anti-ichthyosis therapy was started. Ectropion of the right eye was corrected, and on follow-up at three months, the patient had a visual acuity of 4 /60 and CFCF in the right and the left eye respectively. CONCLUSION: In patients with cicatricial ectropion and dry eye secondary to ichthyosis, corneal health should be closely monitored because of the perforation risk.

Malignant transformation of kissing nevus- a rare entity.

BACKGROUND: Kissing nevus is a congenital nevus in adjacent parts of the eyelids. Malignant transformation of kissing or divided nevi of the eyelids is rarely described. OBJECTIVE: To report a very rare case of malignant transformation of kissing nevus with ocular and extraocular spread. CASE: A 57- year- old man with 6/6 visual acuity in both eyes presented with a kissing nevus present since birth in right upper and lower eyelids which had a slow growth phase. The upper lid in the area of the nevus was thickened with a 20x12x15 mm black pigmented crusted hemorrhagic nodular lesions. The lower lid had a 6 mm black pigmented ulcerated lesion over the pre-existing nevus in the lateral third of the lid with full thickness infiltration. Another 5x4 mm pigmented lesion over the lower medial lid margin with a thickness of about 3 mm extended to the conjunctival side of the lower lid. Right sided pre-auricular and sub-maxillary nodes were palpable. A biopsy of tissue samples from the eyelid and pre-auricular nodes were consistent with malignant melanoma. CONCLUSION: Malignant transformation of kissing nevus is rare. It can spread to the conjunctiva,pre-auricular and sub-mandibular lymphnodes.

Ocular manifestations in herpes zoster ophthalmicus.

BACKGROUND: Ocular complications of herpes zoster ophthalmicus (HZO) may lead to substantial visual disability, severe post-herpetic neuralgia and rarely fatal cerebral complications. AIM: To identify the pattern of ocular manifestation in herpes zoster ophthalmicus. MATERIALS AND METHODS: A cross-sectional descriptive study was under taken including the clinically diagnosed cases of HZO. All of them underwent a complete ophthalmological evaluation. RESULTS: Sixty-eight cases of HZO were examined, of which 37 (54.4 %) were male and 31 (45.6%) female. The mean age was 48.7 ± 18.5 years. Most of the patients (64.7 %) were above the age of 40 years. 77.94 % of the patients had some form of ocular involvement. Pain (77.9 %) was the commonest ocular complaint. In young patients less than 35 years, HIV was the most common risk factor (19.3 %).Visual status was good in the majority (73.5 %) of patients at presentation. Lid and adnexal findings (45.8 %) were most common ocular involvement followed by conjunctivitis (41.1 %). Corneal complication was seen in 38.2 % of cases, uveitis in 19.1 % and post-herpetic neuralgia (PHN) and secondary glaucoma each in 5.8 %. CONCLUSION: Eyelid and ocular adnexal involvement is most commonly found in patients with herpes zoster ophthalmicus followed by corneal complication and uveitis. There needs to be awareness of ocular involvement, which can be sight threatening, among the HZO patients and other medical departments and an increased emphasis on regular ophthalmic examination.

Prospective study of pattern of breast diseases at Nepalgunj Medical College (NGMC), Nepal.

INTRODUCTION: Patients of breast diseases of female are very common cases attending surgical out patient department for treatment at NGMC, Banke, Nepal. OBJECTIVES: To find out the magnitude of the breast diseases, its frequency distribution in different age group among the patients attending surgical OPD for surgical consultation. MATERIAL AND METHOD: This is a prospective study conducted at NGMC, Nepalgunj, Nepal. Patients attending surgical OPD for one or another breast problem were included. They were assessed clinically and their diagnosis was confirmed by cytological (FNAC) or histopathological (biopsy) examination. Then they were subjected to appropriate treatment. It must be mentioned at the outset that no clinical mammography could be done in the case of this study as these facilities are not available at NGMC. RESULTS: 264 cases of breast disease were diagnosed. This includes 232 female and 32 male patients. The ratio between benign and malignant lesions was 13.6:1. The benign breast diseases (BBD) were the commonest lesions of the breast found in this study (93.2%) whereas malignant lesion was infrequent (6.8%). Among BBD, the commonest lesion was fibroadenoma (32.57%) followed by breast abscess (24.19%), Aberration of Normal Development and Involution (ANDI) which was 16.63% and gynecomastia (11.34%). 18 cases (6.80%) were of malignant lesion. This includes 16 female and 2 male cases. The common ages for BBD were, 20-40 years for fibroadenoma, 15-40 years for breast abscess, 18-40 years for ANDI and 10-19, 50-59 for gynecomastia respectively, whereas carcinoma breast was common in the age group of forties and fifties. CONCLUSION: We conclude from this study that BBD were the most frequent breast lesion. Among the BBD fibroadenoma was the commonest lesion. Breast carcinoma cases were less frequent and reached to the hospital in very late stage of the disease.

Impact of torture on refugees displaced within the developing world: symptomatology among Bhutanese refugees in Nepal.

CONTEXT: Most of the world's refugees are displaced within the developing world. The impact of torture on such refugees is unknown. OBJECTIVE: To examine the impact of torture on Bhutanese refugees in Nepal. DESIGN: Case-control survey. Interviews were conducted by local physicians and included demographics, questions related to the torture experienced, a checklist of 40 medical complaints, and measures of posttraumatic stress disorder (PTSD), anxiety, and depression. SETTING: Bhutanese refugee community in the United Nations refugee camps in the Terai in eastern Nepal. PARTICIPANTS: A random sample of 526 tortured refugees and a control group of 526 nontortured refugees matched for age and sex. MAIN OUTCOME MEASURES: The Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) criteria for PTSD and the Hopkins Symptom Checklist-25 (HSCL-25) for depression and anxiety. RESULTS: The 2 groups were similar on most demographic variables. The tortured refugees, as a group, suffered more on 15 of 17 DSM-III-RPTSD symptoms (P<.005) and had higher HSCL-25 anxiety and depression scores (P<.001) than nontortured refugees. Logistic regression analysis showed that history of torture predicted PTSD symptoms (odds ratio [OR], 4.6; 95% confidence interval [CI], 2.7-8.0), depression symptoms (OR, 1.9; 95% CI, 1.4-2.6), and anxiety symptoms (OR, 1.5; 95% CI, 1.1-1.9). Torture survivors who were Buddhist were less likely to be depressed (OR, 0.5; 95% CI, 0.3-0.9) or anxious (OR, 0.7; 95% CI, 0.4-1.0). Those who were male were less likely to experience anxiety (OR, 0.66; 95% CI, 0.44-1.00). Tortured refugees also presented more musculoskeletal system- and respiratory system-related complaints (P<.001 for both). CONCLUSION: Torture plays a significant role in the development of PTSD, depression, and anxiety symptoms among refugees from Bhutan living in the developing world.